VA Research Update: Back Pain Treatments

This article appears in the Spring 2015 edition of Veterans’ Wellness - A Guide to Healthy Living for Veterans in Upstate New York[1]

Back pain - specifically lower back pain - is very common among Veterans and causes significant disability. Given the prevalence of this condition, the Canandaigua VA Medical Center is carrying out three studies to help identify effective treatments.

Results of two of the studies, which involved 380 Veterans from the Greater Rochester area, were recently published in the journals Chiropractic &Manual Therapies  and Geriatric Orthopaedic Surgery & Rehabilitation. The third study is expected to be completed in December, according to Paul Dougherty, DC, staff chiropractor and chiropractic residency director at Canandaigua VA Medical Center and Institutional Review Board chair at Syracuse VA Medical Center.

“Our research so far shows that treatments including spinal manipulative therapy and active exercise can relieve lower back pain,” Dougherty says. In spinal manipulative therapy, a chiropractor applies pressure to the spine to promote movement in spinal joints that are not moving well. Active exercise is exercise patients perform on their own at a doctor’s direction.

Another finding is that fear of pain may actually make back pain worse. “It is important that people with lower back pain continue to remain active and engaged in their lives and not let the pain defeat them,” he says. “If you are suffering from lower back pain, talk to your VA provider about what treatment alternatives are best for you.”

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[1] DeLancey, Darlene A., M.S., and Kathleen Hider, eds. "VA Research Update: Back Pain Treatments." Veterans' Wellness Spring 2015: 11. Print.

Chiropractors in Ridgway, Pennsylvania

From the bottom of our hearts, Dr. Fralick and I would like to thank all of you in the Greater Ridgway area for your support and interest in our practice at 205 Main Street. You have really made us feel very welcome!!

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Daily Health Update for Tuesday, April 07, 2015

“To the best of our ability, Life in Motion Chiropractic and Wellness agrees to provide our patients convenient, affordable, and mainstream Chiropractic care. We will not use unnecessary long-term treatment plans and/or therapies.”

www.Chiro-Trust.org

Mental Attitude: A Sense of Purpose Is Important for Heart Health.

A review of past research involving more than 137,000 individuals found that living a life with a strong sense of purpose may lower a person's risk of early death, heart attack, and stroke. Compared with those lacking a sense of meaning and direction in life, researchers found that study participants possessing a strong sense of purpose had a 23% reduced risk of premature death from any cause and a 19% lower risk for cardiovascular-related events such as heart attack or stroke. Study author Dr. Randy Cohen writes, "Purpose in life is considered a basic psychological need, and has been defined as a sense of meaning and direction in one's life, which gives the feeling that life is worth living."

American Heart Association, March 2015

Health Alert: Air Pollution May Increase Stroke Risk.

A new study has discovered that high levels of small-particle air pollution can increase an individual's risk for narrowing of the carotid arteries in the neck, a risk factor for stroke. The findings come from screening tests of more than 300,000 people living in New York. Investigators found that those who live in areas with high levels of air pollution were 24% more likely to have narrowing of the arteries that deliver blood to the brain. Lead author Dr. Jonathan Newman adds, "If you're in good health, the level of air pollution we see in most parts of the United States probably doesn't pose a significant health risk to you. But for people who are very young, very old, or have other medical problems, air pollution could be a significant source of cardiovascular disease risk."

American College of Cardiology, March 2015

Diet: Lycopene May Reduce Risk of Kidney Cancer in Older Women.

Lycopene is an antioxidant compound commonly advertised as a component of tomatoes and tomato products. An analysis of data from over 96,000 postmenopausal women revealed that a higher intake of lycopene is associated with up to a 39% reduced risk for developing renal cell carcinoma.

Cancer, February 2015

Exercise: Can Interactive Cycling Games Provide an Alternative to Conventional Exercise?

Scientists recently compared the physiological and enjoyment responses between conventional cycling and interactive video game cycling. They found that interactive video game cycling was more enjoyable for study participants and led to a higher overall energy expenditure. Based on these findings, the researchers concluded that interactive cycling games could be a suitable alternative to conventional exercise.

PLOS ONE, March 2015

Chiropractic: Back Pain Prevalence and Obesity Around the World.

Using data collected from 42,116 individuals from nine countries across five continents, researchers have found that obesity can increase an individual's risk for back pain 1.4 to 3.3 times when compared with their countrymen whose body mass index scores fall in the normal range. While further studies are needed to identify what factors lead to greater back pain risk for obese adults in some countries, it's clear that maintaining a healthy weight should be an important part of everyone's back pain prevention strategy.

BMC Public Health, February 2015

Wellness/Prevention: This May Slow Cardiovascular Disease in Patients with Kidney Disease.

For kidney disease patients, cardiovascular disease is the main cause of morbidity and mortality. An animal-based study looked at the effect of daily exercise on mice with compromised kidney function. Compared with sedentary mice, researchers observed considerably less aortic plaque build-up in the mice that exercised. Further research is necessary to verify these findings and eventually determine if such benefits translate to human kidney disease patients.

PLOS ONE, March 2015

Daily Health Update for Monday, 06 April 2015

“To the best of our ability, Life in Motion Chiropractic and Wellness agrees to provide our patients convenient, affordable, and mainstream Chiropractic care. We will not use unnecessary long-term treatment plans and/or therapies.”

www.Chiro-Trust.org

Mental Attitude: Is COPD Linked to Dementia?

For those needing more reasons to avoid cigarette smoke and other forms of air pollution, a new study notes an association between chronic obstructive pulmonary disease (COPD) and mild cognitive impairment, a risk factor for dementia.

Alzheimer's Research & Therapy, March 2015

Health Alert: New CPR Devices Approved by FDA.

The ResQCPR system involves two new devices that can be used together to aid people who require cardiopulmonary resuscitation (CPR). The first device is called the ResQPump, which attaches to a person’s chest with a suction cup, making it easier for the rescuer to compress and decompress the chest during CPR. The second device, the ResQPod, fits onto a rescue mask or breathing tube to help reduce pressure inside the victim’s chest, which helps draw more blood to the heart. The Food and Drug Administration (FDA) says that when used together, the devices help increase the amount of oxygenated blood that circulates through the patient's body during CPR and thus increases their chance of survival.

Food and Drug Administration, March 2015

Diet: Vegetarian Diet May Reduce Risk of Colon Cancer.

A new study involving more than 77,000 adults has found that a vegetarian diet may cut an individual's risk of colorectal cancer by 20%. The researchers believe the benefit is mainly the result of eating less red and processed meat (both of which have been associated with a high risk for colorectal cancer) and eating more fiber-rich foods in the form of fruits and vegetables (which have been linked to a reduced risk for the disease).

JAMA Internal Medicine, March 2015

Exercise: How to Shop for Athletic Shoes.

It is essential to wear a properly fitted and supportive pair of shoes when exercising. The American Orthopedic Foot and Ankle Society offers the following tips: shop at a specialty store to take advantage of their expertise, try on shoes at the end of the day when your feet are largest, wear the socks you usually wear when exercising, make sure you can easily move your toes after lacing them up, walk or run a few steps to test that the shoes firmly grip your heels, and look for a sport-specific shoe if you plan to play a particular sport.

The American Orthopaedic Foot and Ankle Society, March 2015

Chiropractic: How Whole Body Vibrations Increase Back Injury Risk…

While exposure to whole body vibrations (WBV) has been identified as a risk factor for a work-related back injury, previous research hasn't determined why this is the case. In a recent study, volunteers lifted a box in front of them from ground level to a waist height platform to the left of their bodies repeatedly during two hour-long sessions. Before one of the sessions, participants sat for an hour on a vibrating platform. An analysis of body movements from both sessions showed that WBV exposure resulted in faster and more exaggerated twisting motions by participants. Over time, such behavioral changes during repeated lifting tasks following WBV exposure may increase an individual's risk for an injury to the lower back.

Journal of Occupational and Environmental Hygiene, March 2015

Wellness/Prevention: Focusing on Sleep Quality and Stress Reduction Helps Reduce Diabetes Risk!

For those at risk for developing type 2 diabetes, a new study recommends focusing on reducing stress and getting quality sleep in addition to increasing physical activity and eating better. Researcher Dr. Mariam Kashani explains, "By taking sleep and stress into account, we factor in important hormonal processes to better manage glucose. When we are stressed, our bodies release extra glucose and when we are tired, we tend to make poor food choices. In this context, people often regain weight, and in doing so, they may revert back to worsening blood glucose levels."

American College of Cardiology's 64th Annual Scientific Session in San Diego, March 2015

This information should not be substituted for medical or chiropractic advice. Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your updated medical history.

Daily Health Update for Friday, 03 Apr 2015

“To the best of our ability, Life in Motion Chiropractic and Wellness agrees to provide our patients convenient, affordable, and mainstream Chiropractic care. We will not use unnecessary long-term treatment plans and/or therapies.”

www.Chiro-Trust.org

 Mental Attitude: Does IQ Determine How Much Alcohol a Young Man Drinks?

Swedish researchers have found that lower male IQ scores are linked to greater risks for heavy and binge drinking behaviors. The research team separated the nearly 50,000 male study participants into nine groups based on IQ scores from highest to lowest. They found that the risk of heavy drinking increased 20% and the risk of binge drinking increased 9% as they moved each level downwards towards the group with the lowest IQ scores. While it’s believed that many factors may influence an individual's alcohol consumption, those with higher IQ scores may be more likely to make lifestyle choices that would steer them clear of situations that encourage heavy drinking.

Alcoholism: Clinical & Experimental Research, March 2015

Health Alert: Family History of Prostate Cancer May Be Linked to Breast Cancer Risk.

A family history of prostate cancer may be tied to a woman’s risk of breast cancer. Researchers found that women whose father, brother, or son have had prostate cancer may have a 14% greater risk of developing breast cancer when compared with women whose male family members have not had prostate cancer. They also found that women with a family history of both prostate and breast cancer have a 78% greater risk of developing breast cancer when compared with women whose family histories have neither. The findings call attention to the need for women to know their complete family medical history, particularly cancer diagnosed among first-degree relatives, including fathers, brothers, and sons.

Cancer, March 2015

Diet: Could This Olive Oil Compound One Day Fight Cancer?

Oleocanthal, a compound in extra virgin olive oil, has been observed to cause cell death in cancer cells; however, scientists have been unable to determine how it worked. Now, researchers claim that oleocanthal acts by rupturing the lysosomes found in cancer cells, causing cell death within 30 minutes while leaving non-cancerous cells untouched. Study co-author Dr. Paul Breslin notes, "The mechanism of killing cancer cells and sparing healthy cells, lysosomal membrane permeabilization, has been hypothesized as a possible mechanism of effectively killing cancer cells and sparing healthy tissues but has never been realized before. Our realization of this makes this paper of particular therapeutic interest for cancer treatment."

Molecular & Cellular Oncology, January 2015

Exercise: Exercise's Effect on the Brain Could Improve Mobility as We Age.

A small study conducted at Rush University Medical Center in Chicago indicates that staying physically active in adulthood may ward off mobility problems later in life. In a study involving 167 seniors, those with a history of physical exercise had higher mobility scores than their peers who were mostly sedentary during their working years, even in the presence of brain deterioration typically associated with movement difficulty among the elderly.

Neurology, March 2015

Chiropractic: Stretching Can Help Office Workers with Neck and Shoulder Pain.

For office workers with chronic neck and shoulder pain, a recent study found that performing neck and shoulder stretching exercises at least three days a week led to significant improvements in both pain and function.

Clinical Rehabilitation, March 2015

Wellness/Prevention: Benefits From Diet & Exercise.

A healthy diet combined with exercise can lead to many benefits. The Weight-Control Information Network lists the following benefits of exercise: keeps your body energized for work and play, improves ability to manage stress, promotes a positive self-image, improves the fit and look of clothing, tones muscles, and creates a positive example for family and friends.

The Weight-Control Information Network, March 2015

This information should not be substituted for medical or chiropractic advice. Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your updated medical history.

Efficient Spine Care in the United States

Back and/or neck pain are a prevalent issue in society today and it is estimated that 149 million work days are lost every year in the United States at a cost of $100-200 billion [i.e. lost wages and decreased productivity] due to low back pain alone.[1]^{,[2], [3]} The World Health Organization reports that currently the primary treatment for low back pain is analgesic medication and that the causes for its provocation are rarely addressed.[4] This ineffectual treatment protocol isn't necessarily the fault of the rendering primary care physician due to their “inadequate preparation for practice in the real world” with regards to musculoskeletal medicine.[5] In November 2014, DiGiovann, et al reported that North American medical schools have limited time devoted to musculoskeletal education and cite that only 30% to 40% of schools have required instruction in the musculoskeletal system.[6]^,[7],[8] This is unfathomable when the average total health expenditure per person with back and/or neck pain in the United States is 73% greater than for individuals in other countries.[9]^,[10] The time has come for a truly unbiased and integrative approach to the treatment of low back and neck pain a fact that has been evident within the medical community since 1999.[11]

In July 2011, Murphy et al published a commentary expressing the need for the implementation of a primary spine practitioner (PSP) to effectively triage patients experiencing spine related disorders (SRDs), conditions that include back pain, neck pain, many types of headache, radiculopathy, and other symptoms directly related to the spine. They state that the PSP “would function as the first contact for patients with SRDs, i.e. the first practitioner that a patient consults when he or she develops a spine problem and could also function as a resource for traditional PCPs (family practice physicians, general internal medicine physicians, pediatric, obstetrical/ gynecological physicians, primary care nurse practitioners or physician’s assistants) to refer patients who present with SRDs”. This implementation exhibits potential benefits to SRD patients (i.e. faster recovery, cost savings, iatrogenic[12] disability avoidance, increased productivity, decreased likelihood of becoming a chronic pain sufferer, high patient satisfaction, focus on prevention), our society ( i.e. knowledgeable care coordinator, SRDs as a public health initiative, improved worker productivity, less long term disability), and the overall healthcare system (i.e. controlling costs, unburdening traditional PCPs, more strategic specialist referrals, disruptive innovation, standardization of care, new evidence and technologies). [13]

Candidates for the role of PSP within our current system would be currently licensed healthcare providers (i.e. chiropractor, physician, physical therapist, nurse practitioner) who would receive additional training based on a spine care pathway which has already been implemented in hospital systems, accountable care organizations, patient centered medical homes,  and privately operated PCP and specialty groups.

The effectiveness of integrative care for SRDs has not only been clinically demonstrated but has been mandated by a renowned medical center’s health plan:

- A 2013 study of Washington state workers who had recently filed worker’s compensation claims due to back injury found a 41.2 percent decrease in lumbar spine surgeries when the claimant consulted a chiropractor first.[14]

- Priority Health a major health plan in Western Michigan found that when they required spine patients who were heading for a non-urgent surgical consultation to first consult a physiatrist, surgical referrals decreased 48 percent, spine surgeries decreased 25 percent, and surgical costs dropped 25.1 percent.[15]

- University of Pittsburgh Medical Center Health Plan requires that patients with chronic back pain undergo a minimum of three months of chiropractic and/or physical therapy before any spine surgery is approved.[16]

So why am I so adamant about this subject? In September 2013, Spine Care Partners in conjunction with Lifetime Health Medical Group and Excellus BlueCross BlueShield commenced the inaugural spine care pathway training which was conducted at Excellus’ corporate headquarters in Rochester, NY. Dr. Fralick and I had the honor of being part of that inaugural class and have experienced first-hand the benefits this evidence based and patient centered program exhibits. Everything the Murphy et al commentary envisioned, at least in regard to SRD patient benefits, has become a reality for the patients who have sought care in our office.

The desire for this integration on a community level became evident to us upon receiving a letter from Excellus Blue Cross/Blue Shield of Rochester dated 29 December 2014. In this letter they outlined a “Waived Copayment Pilot Program” whose purpose is to “help drive care to spine pathway trained practitioners so that the program’s value can be measured and compared to other modalities of treatment for back and neck pain”. This program will extend until 31 December 2015 and only include Excellus employees and their covered family members but underlines the fact that a major health insurer believes PSPs are credible portal of entry providers for patients who present with musculoskeletal conditions.

So I urge all of you who are reading this to share this information with your healthcare providers and encourage them to seek out these practitioners in your community and integrate them into their treatment plans for spine related disorders.   

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[1] Guo HR, Tanaka S, Halperin WE, Cameron LL. Back pain prevalence in US industry and estimates of lost workdays. Am J Public Health, 1999, 89(7):1029-1035.

[2] Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am, 2006, 88(suppl 2):21-24.

[3] Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin, 2007, 25(2):353-371

[4] Duthey, Beatrice, PhD. "Background Paper 6.24 - Low Back Pain." Priority Medicines for Europe and the World 2013 Update. Background Paper 6 - Priority Diseases and Reasons for Inclusion. BP 6.13 to 6.24 (part 2). World Health Organization, 15 Mar. 2013. Web. 11 Mar. 2015. <http://www.who.int/medicines/areas/priority_medicines/BP6_24LBP.pdf>.

[5] Association of American Medical Colleges. Medical School Objectives Project. Contemporary issues in medicine: musculoskeletal medicine education. Report VII. 2005.

[6] DiGiovann, Benedict F., , MD, Richard D. Southgate, , MD, Christopher J. Mooney, , MA, MPH, Jennifer Y. Chu, , MD, David R. Lambert, , MD, and Regis J. O’Keefe, , MD, PhD. "Factors Impacting Musculoskeletal Knowledge and Clinical Confidence in Graduating Medical Students."The Journal of Bone and Joint Surgery E185 96.21 (2014): n. pag. The Journal of Bone and Joint Surgery, Inc. The Journal of Bone and Joint Surgery, Inc.; STRIATUS Orthopaedic Communications, 05 Nov. 2014. Web. 17 Jan. 2015. <http://jbjs.org/content/96/21/e185>.

[7] DiCaprio MR, Covey A, Bernstein J. Curricular requirements for musculoskeletal medicine in American medical schools. J Bone Joint Surg Am. 2003 Mar;85(3):565-7.FREE Full Text

[8] Pinney SJ, Regan WD. Educating medical students about musculoskeletal problems. Are community needs reflected in the curricula of Canadian medical schools? J Bone Joint Surg Am. 2001 Sep;83(9):1317-20. Abstract/FREE Full Text

[9] Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingsworth W, Sullivan SD. Expenditures and

health status among adults with back and neck problems. JAMA, 2008;299(6):656-664.

[10] Rosner, Anthony. "Going About Spine Care the Wrong Way - Spine Care "bass-ackwards."" Dynamic

Chiropractic - News, Articles, Research & Information for Chiropractors. MPA Media, 01 Jan. 2014. Web.

10 June 2014. <http://www.lifeinmotionchiro.com/Educational%20Brochures/Going-About-Spine-Care-the-Wrong-Way.pdf>. Vol. 32, Issue 01

[11] Andersson GB, et al. A comparison of osteopathic spinal manipulation with standard carefor patients with low back pain. N Engl J Med 1999;341: 1426-1431

[12] of or relating to illness caused by medical examination or treatment.

[13] Murphy et al. The establishment of a primary spine care practitioner and its benefits to health care reform

in the United States. Chiropractic & Manual Therapies 2011, 19:17 http://chiromt.com/content/19/1/17

[14] Keeney B, Fulton-Kehoe D, Turner J. Wickizer TM, Chan KC, Franklin GM. Early predictors of spine

surgery after occupational back injury: results from a prospective study of workers in Washington

State. Spine, 2013;38(11):953-964.

[15] Fox J, Haig AJ, Todey B, Challa S.. The effect of required physiatrist consultation on surgery rates for back

pain. Spine, 2013;38(3):e178-e184.

[16] "DC Receives Federal Grant to Study Nonsurgical Alternatives to Surgery for Spinal Stenosis: Interview

With Michael Schneider, DC, PhD." Health Insights Today, March 2013.